Jacky Mathonnat chaired a panel session on whether PBF represents a paradigm shift in the aid sector. The main objective was to check with aid agencies if the PBF strategy affects or will affect their models and instruments for channeling assistance to recipient countries or organizations. This made for a lively and at times provocative debate. We summarize some of the ideas that were put forward, without specifying which representative made the particular statements.
(Participants of the round table were: Frank Van de Looij (Cordaid), Laurent Musango (WHO/Afro), Agnès Soucat (WB), Bénédicte Brusset (AFD), Ingvar Olsen (NORAD), Pierre Cavert (EC, Burundi) and Yogesh Rajkotia (USAID, Rwanda).)
1. PBF can be found at many levels: it’s not just a national strategy (in the US government for example, PB contracts have been pretty common for a while now) but also globally results based financing is the ‘talk of the town’. There is more and more a focus on results in Global Health Initiatives (like Gavi); increasingly funds are going through these channels. The paradigm shift is thus not only visible at country level, but also globally. Somebody aptly remarked that aid will cease to be relevant if it can’t show results. At least part of the aid architecture is moving in the direction of “SWAP with teeth” (boosted with results). Obama’s Global Health Initiative will most likely share this results based approach. Having said that, it remains to be seen to what extent things in the next decade or so will continue to resemble the “We get it, but we still don’t implement it” comment, made by one participant, referring to his organization. On the other hand, institutions and organizations should also refrain from proceeding too quickly with PBF reform, as a lot of donor fatigue is due to the need for immediate results.
2. Several participants emphasized that it is vital to get the PBF message right. Results based financing is not P4P, as it forces us to examine the whole chain of where the money goes. A broader human resources reform is crucial: just providing bonuses and salary supplements to civil servants is definitely not the way to go. One should thus not interpret RBF in a narrow sense. Design matters. The core is about autonomy and reform for which you need to engage with all (and preferably also high-level) stakeholders. Burundi is a case in point. Success hinges on this discussion with key actors, one should definitely not just push through one’s own agenda. Last but not least, just dealing with MoH does not suffice, as it often lacks political weight. At the very least, MoF should also be involved, as it plays a key role in the new aid architecture (with budget support).
3. PBF is complex and requires resources but the strategy also provides plenty of opportunities. It can treat existing problems, trigger reforms (like the autonomy of health facilities, decentralization ), contribute to a unified health information system, induce a new dialogue with actors that had so far escaped sector dialogue ( some vertical actors for example ), and the health sector can also constitute a PBF pilot sector for other public sectors.
4. In terms of the process, NGOs can play a useful role in starting PBF pilots in countries. When scaling-up, however, other skills become necessary (like advocacy skills, building networks, …) as then leadership of Government becomes much more essential.
5. Another issue raised during the discussion was whether PBF increases the fragmentation risk and can be at odds with the budget reform goal. Fragmentation risk is definitely an issue, some participants noted. By way of example, somebody referred to PBF for HIV service delivery in Ethiopia, happening somewhat outside the public health system (set-up of parallel PBF units). Another participant stressed that, even if one enthusiastically embraces the Paris declaration goals, still, in practice things can go terribly wrong in some countries.
6. Finally, a participant mentioned that the Ministry of Finance is often, unsurprisingly, reluctant to have big chunks of money going to public-private fund holders (like the provincial fund holders in DRC). One explanation is that the PFM Performance Measurement Framework, which has been developed by donors engaged in budget support under the PEFA (Public Expenditure & Financial Accountability: http://www.pefa.org) program, discourages the transfer of public budget resources to mixed entities. Obviously, many actors have still to adapt their instruments to result based financing.